LIZBETH POTTS, P.A. 9358 North 56th Street, Suite 311 Temple Terrace, Florida 33617 (813) 988-9190 [email protected] Initial Client Consultation Interview Form Step 1 of 4 25% The purpose of an initial consultation is for the attorney to advise you, the prospective client what, if anything, may be done for you, and what the minimum fee will be. The purpose is not to render a definitive legal opinion as it may be impossible to fully assess a matter within the time frame allotted for a consultation or with the (information or documents) that you may be able to provide at the initial consultation. One of three outcomes is possible following your consultation: You and the Attorney mutually agree to the terms of representation, or (After a separate document called a Retainer Agreement is signed and a copy will be provided to you). The Attorney declines representation, or You decide not to use the services of the Attorney. NOTE: The following questions will help us to better understand the reason for your visit today. Your responses are protected by attorney-client privilege and will be held in strict confidence. Name Name First Middle or Maiden Address CellHome phoneE-Mail: Where are you employed? May we contact you there? Yes No DOB MM slash DD slash YYYY Driver License No.How did you learn about our office? Friend/Relative Former client Temple Terrace Chamber/Uptown Chamber of Commerce Other Attorney Website- www.liz-law.com Website- www.basslawgroup.com Other Are you a resident of Florida? Yes No Do You Own home Rent/Lease Untitled Are there other parties involved? (Example: a spouse, a friend, a signor on a contract, someone who passed away, etc. This should include people or parties on either side of your issue)PartyRelationship On the lines below, list the papers (documents) that you have brought with you today OR that you think may help us to better understand the issues.Untitled Untitled Untitled Please classify your urgency in concluding this matter? (Check one) Critical- personal safety depends on it. Very important- severe hardship, personal or financial inconvenience if matter is not resolved quickly. Important- matter interferes with business or personal financial stability. Needs to be done, but no immediate hardship in the interim. Just thought I’d see if it was worth pursuing, but I’m not counting on anything. Just wanted to know what my rights are. I’ll then let you know after I think about it. Are we the first attorney you have consulted regarding this matter? Yes No Untitled Have you ever been represented by an attorney before? Yes No If Yes, please state the circumstances If your mail is returned as undeliverable or your phone service is terminated, please provide the name of someone (friend or relative) you believe will always know how to contact you.Name Relationship AddressPhone PLEASE READ CAREFULLY and SIGN BELOW Following your initial consultation, if you agree to hire the Attorney and the Attorney agrees to represent you, you will both sign a Retainer Agreement. The Retainer Agreement will set forth the terms and conditions of representation. If the Attorney quotes a retainer amount, that amount is VALID FOR 30 DAYS FROM THE DATE OF THIS SIGNED DOCUMENT. If the Attorney is willing to represent you and you decide not to sign an Agreement of Representation today, you are strongly urged to schedule a second appointment with the Attorney at the earliest possible time or to immediately consult with other legal counsel to protect your rights. NOTICE: This office does not represent you with regard to the matter set forth by you in this Initial Client Consultation Interview Form or discussed during your consultation. You and the Attorney must execute a written Retainer Agreement in order for the Attorney to represent you. If the Attorney does not agree to represent you, this includes not representing you with regard to the matter set forth by you in this information sheet, nor any other matters you may discuss with the Attorney during your consultation. If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney strongly recommends you to immediately consult with another attorney to protect your rights. The Attorney’s decision not to represent you should not be taken by you as an expression regarding the merits of your case. **Your signature acknowledges only that you understand you have not hired the Attorney, but may have discussed a legal matter with the Attorney.** Signature Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged. Δ
